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General NPI Number Information
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NPI Number | 1033927504
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Entity Type | Individual
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Provider Name | MATTHEW PELLERITE RD
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Gender | Male
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 300 NIAGARA ST
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City | BUFFALO
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State | NY
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Zip | 14201-2135
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Country | US
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Telephone | 716-242-8600
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Fax | 716-332-0832
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Provider Business Mailing Address
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Address Line | 155 LAWN AVE
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City | BUFFALO
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State | NY
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Zip | 14207-1816
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Country | US
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Telephone | 716-875-2904
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Fax | 716-875-6717
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 010506
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License Number State | NY
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